20170320143705.pdfILA CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERNM MUST BE POSTED ON JOBSTTE*
STATUS: ISSUED ENG20170097
SIDE SEWER PERMIT (I -Single Fan-dly)
Permit Number: ENG20170097 Expiration Date: 06/19/2017
Job Address: 17604 OLYMPIC VIEW DR, EDMONDS
SEWER FRIENDLY
17604 OLYMPIC VIEW DR PO BOX 3415
EDMONDS, WA 98026-5636 LYNNWOOD, WA 98046
(206) 890-7478
I.TCFNSF4-SFWF.RFI.916MS FXP-07/10/2017
.JOB DESCRIPTION
__Y�REPAIR N PROPOSE TO REUSE LATERAL LIDNUMBER:
N I GRINDER PUMP N I PROPOSE TO REUSE SIDE SEWER N 1 DRAINAGE
PIPEBURSTINGSS FROM HOUSETO PROPERTYLINE
4" CLEANOUT TO BE ADDED AT HOUSE AND 6" CLEANOUT AT PROPERTY LINE
EASEMENT INFORMATION
Nd PROJECT CROSSES OTHER PRIVATE PROPERTY
N VERIFICATION OF RECORDED EASEMENTS COMPLETE
IADEMNITY- The Applicant has signed an application which states helshe holds the City ofEdmonds harmlessfrom injuries,
damages or claims ofany kind or description whalsoever, foreseen or unforeseen, that may be made against the City ofEdmonds or
any ofils departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
attorneyfees by reason ofgranting thispermil.
CALL DIALA-DIG (1-800-424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NOTTCEREQUIRED FOR ALL INSPECTTON REQUESTS
THISAPPLICATTON IS NOTA PER3V[ITUN'11L SIGNED BY THE CITY ENGINEER OR HISMER DEPUTY: AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED IN
SPACE PRONADED.
Printed: Monday. March 20. 2017
RELEASED BY DATE'
F FILE COPY E] INSPECTORCOPY
APPLICANT COPY
STATUS: ISSUED
ENG20170097
• Refer to City of Edmonds Side Sewer Information handout for approved pipe materials, inspections and other requirements.
• A 6" cleanout with 12" locking cast iron laniphole cover is required at the property line.
• Maintain 10'separation between the sanitary side sewer and the water service line.
• A separate right-of-way construction permit is required for work within the City right-of-way.
• Condition of the existing lateral to be verified by the City's Public Works Dept. to obtain approval for reuse. Contact Edmonds
Sewer Division at 425-771-0235.
• Condition of the existing sanitary side sewerto be verified priorto obtaining approval for reuse. TVinspection required. Video
to be submitted to City for review.
• Easement and/or permission fi-om adjacent property owner is required prior to entry /work within adjacent property.
• Applicant shall repair/replace all damage to utilities or frontage improvements in City right-of-way per City standards that is
caused by or occurs during the permitted project.
• Owner/Contractor to provide Side Sewer as built at final inspection. See City Standards for requirements.
• Sound/Noise originating from temporary construction sites as a result of construction activity are exempt from the noise limits
of ECC Chapter 5.30 only during the hours of 7:00amto 6:00pmon weekdays and 10:00am and 6:00pm on Saturdays, excluding
Sundays and Federal Holidays. At all other times the noise originating from construction sites/activities must comply with the
noise limits of Chapter 5.30, unless a variance has been granted pursuant to ECC 5.30.120.
• Applicant, on behalf of his or her spouse, heirs, assigns, and successors in interests, agrees to indemnify defend and hold
harmless the City of Edmonds, Washington, its officials, employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance ofthis pennit. Issuance of this pen -nit shall not be deemed to
modify, waive or reduce any requirements of any City ordinance not limit in any way the City's ability to enforce any ordinance
provision.
• E-Sanitary Side Sewer Inspection
• E-WATER TEST/TV/CLEANOUT AT PL
0 CONTRA C70R TO PROVIDE ASBUILT
PARTIAL INSPEC71ON DATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL:
.10 01: -VA1041,
SIDE SEWER
PERMIT APPLICATION
CONTRACTOR INFORMATION:
Company Name:
Site Contact: fi6b
Mailing Address: �217
State License #:
Expiration Date:
City Business License #:
PROPERTY INFORMATION:
Address: / 7�'o it 01
Owner'sName:
Phone 4:
rr el-\
Phone
Fax #:
Email#: A.,�
F-1 Liability Insurance El Bonded
F-1 Full Line Replacement 0 Spot Repair �OKipe Burst E] Reline (PermaLine Only)
DESCRIPTION OF PROPOSED WORK (Be Specific):
SIGNATURE 1�a'al DATE
Contractor or Agent
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE